Table 2 Guidelines to providing a psychologically safe learning environment for students

These guidelines are designed to help you as a preceptor apply a standardised approach to providing a psychologically safe learning environment for your students.

Prior to Meeting Student

Steps

Rationale

Examples

Formulate a set of questions specific to your area of nursing

This will help activate the learning process for students

Choose questions suitable to your clinical area.

Identify and reflect on any unconscious negative bias (towards students), so you can act to remove them.

Unconscious bias happens when we allow our attitudes, feelings, stereotypes, or beliefs to impact our judgement or understanding of students.

Unconscious bias also affects how you communicate. It can affect the morale and the overall experience of the students. They may feel alienated and be less likely to make their ideas heard. Your nonverbal communication can give away your underlying bias, resulting in students feeling unwanted and a loss of confidence.

Stereotyping students, e.g., all students are not interested in learning, ageism, gender bias, bias relating to students’ stage of their programme (1st years have little knowledge or skills, fourth-years should be able to do everything).

Initial Meeting Student

Steps

Rationale

Examples

Introduce yourself at the first opportunity

Be proactive to introduce yourself. Establishing yourself as an open, friendly, and professional individual will “break the ice” and display warmth, acceptance, and a sense of inclusion, encouraging the student to engage with you.

“Hello, my name is ....... I will be your preceptor. You are very welcome”.

Identify how the student likes to be addressed and how to pronounce their name

Calling a person by their preferred name shows respect. It helps provide an empowering, safe, and non-discriminatory educational and work environment. A name is an extremely important part of a person’s identity; mispronunciation of their name can cause insult, signalling to the student that they are less important and less valued.

“It is so lovely to talk with you, (insert name)- Do you prefer (insert name) or do you go by another name?

“What do you like to be called"?

“I want to make sure that I say your name correctly. Could you pronounce your name for me, please”?

Define and communicate the purpose of the professional relationship and your role as their preceptor

To feel a part of the preceptorship relationship, the student must understand the purpose of the relationship, your role as their preceptor, and how it will work. It creates an open and transparent relationship with a clear understanding of the purpose and role in the relationship.

“I will be working with you over the next few weeks; I am here to work alongside you in providing patient care, teach you, provide you feedback and assess your level of competency throughout your placement. I am here to answer any questions you may have and help you achieve your learning goals for the placement ”.

Build a rapport by sharing appropriate background and experiences about yourself; Ask students questions to discover their interests.

Providing students with a summary of your experience to date and appropriate personal information helps build a friendly and inviting rapport. Asking students about their experiences and personal interests helps create a common ground.

“I have worked on a surgical ward for 10 yrs. Prior to working here..... I was drawn to nursing because ........etc

Tell me a little about yourself?

What experience have you had to date?

Do you have any hobbies”

Collaborate with the student to set concrete and time-bound learning goals

Students do better when they feel in control of their learning. Working with your students to set reasonable but achievable goals in the placement timeframe drives their learning and makes them feel they are leading their learning. Reassuring students that learning takes place over a period of time aids their ability in setting realistic expectations.

“What would you like to learn on this placement?”

“I would like you to achieve the following......how does that sound to you?”

“I feel you can achieve the following learning objectives during your placement ...... how does that sound to you? Is there anything else you would like to learn? “

Communicate a vision of the student's potential

Helping the student see what they can do can stimulate the student’s motivation to learn.

“I think that you will get on great during your placement, you have a great knowledge base starting, and you are extremely capable of passing this placement.” Alternatively, more specific, “I think you will be able to complete a full pre-op assessment by the end of the week. You are already doing most of it on your own. Keep up the good work!”.

Identify with your students each other’s strengths and weaknesses in areas of nursing

Identifying and utilising your strengths has been linked to an elevated sense of vitality and motivation, increased probability of achieving goals, and a stronger sense of direction. It is also linked to higher self-confidence, engagement, and productivity. Actively and creatively reflecting and problem-solving around your strengths and weaknesses can motivate you to improve. It also builds team cohesion and builds trust as you help each other improve areas of weakness.

Identifying each other’s strengths and weaknesses; for example, being good at medications and communicating with patients, requires improvement in managing patient workload and dressings.

“ What do you feel are your strongest and weakest areas of clinical practice?”

“What aspects of nursing do you feel you are good at?”

“What areas do you feel you could improve on?”

Identity students’ triggers for stress

It is crucial to identify the triggers that might affect a student’s academic, social, emotional, and behavioural status during their practice placements. Academic stressors, interpersonal stressors, and environmental stressors influence students’ health and feeling of psychological safety during their practice placements.

For example, a student could state, if I do not hand over completely before we finish, I lay in bed at night wondering did I do this, did I sign that form etc. To avoid this, ensure to include students in the handover process, thank them for their days' work, and enjoy their evening.

Alternatively, another student may find speaking to a packed room in handover extremely stressful. Work with the student to overcome this, maybe start with one patient and then build it up to complete handover.

Continued Student Relationship

Steps

Rationale

Examples

Conduct frequent touchpoints

Frequent interactions are more effective than long, infrequent ones. Frequency builds and strengthens connections.

Have short daily one to one meetings to provide oral feedback to students instead of 2-to 3 long formal NCAD meetings. Touch base with your student throughout the day, agree on 3-4 check-ins per shift, keep communication open and create a safe environment to ask questions.

Model a positive mindset to learning. Get to know their preferred learning style.

This makes learning a collaboration (you will learn from the student also).

Share something new that you learned to demonstrate that learning is ongoing and that you do not know everything. Establishing their learning style will also put the student at ease, creating a psychologically safe environment.

Get to know their preferred working style.

Encourages effective teamwork and reduces the risk of conflict.

What way shall we plan our day? Do you prefer to take four patients each, or shall we team nurse and break up the workload for all eight patients?

Share past mistakes.

Creates a culture to discuss mistakes without blame or repercussions. Reduces students' stress if an error does occur, thus improving their learning experience. Sharing mistakes also creates vulnerability, thus further connecting student and nurse relationships.

Stating that every nurse is likely to make a mistake at some point in their career, providing an example.

If a student makes a mistake, do not judge or reprimand them. Reinforce their effort into achieving the skill, highlight how it can be improved, and ask how you can help them achieve this.

Making mistakes during placements should be a learning opportunity to improve your students' practice. Reinforcing their effort and highlighting areas for improvement will help create a non-judgemental, fear of failure teaching environment for your students.

“Well done on administering your first sub-cut injection. You did a great job following the ten rights and putting the patient at ease; make sure next time you bring the sharps bin right over to the patient; you increase the risk of a needle stick injury if you leave it on the bedside table. Overall, well done. You did a great job”.

Express gratitude and appreciation towards students for their input to the team

This further helps establish an inclusive and appreciative environment where the student feels valued and part of the team, resulting in a positive clinical learning environment.

Sometimes, something as simple as a 'thank you goes a long way!

“Thank you for all your work today. I would not have managed without you. We work well together as a team. I appreciated all the work you did”.

“Your compassion, optimism and kindness to your patients do not go unnoticed....”

Demonstrate learning empathy

Understanding and stating that you know what one student might find easy another may struggle with. You also appreciate that students have a lot to remember and that you remember being a student and being worried and stressed will help create a psychologically safe learning environment for the student as your level of understanding and empathy will put the student at ease and build their trust in the relationship.

“I want you to know that I remember what it is like to be a student, so please do not be afraid to ask me questions or show you something again if you do not get it the first time. I know how students feel overwhelmed and stressed at times. Let me know if you feel like that in any way, and we will work together to sort it out”.

Admit when you do not know something

Being open and admitting you do not know something creates trust between you and your student, creating a stronger open and transparent relationship and, therefore, a positive learning environment.

“I should know what this medication is for, but to be honest, I cannot remember. Let us look it up together so we can learn together”.

Ask the student for feedback and embrace it

Asking students for feedback creates a bidirectional feedback opportunity that helps reduce hierarchical relationships creating an equal relationship where both parties’ views are appreciated and an opportunity to reflect and improve for future practice.

“Did you learn everything you feel you set out to learn on this placement?

Is there anything I could have done differently as your preceptor to better your clinical placement?

Did you feel the frequency and level of feedback you received were suitable to help you achieve your learning goals? “

Offer support to a student you can see is struggling

Offering support creates psychological safety as it shows the student that you care about the student and their education.

Talk to your students. What are they struggling with outside of the classroom? Are they overwhelmed by work or family commitments? Perhaps they could use some coaching around time management. Or a more difficult question involves asking for an honest answer about how much effort they are putting into studying

General Rules

Steps

Rationale

Examples

Physically face students when talking to them, make eye contact

Making eye contact helps both preceptor and student or patient focus on the conversation, and reading facial expressions can improve understanding, thus significantly improving communication and personal connections.

Please do not write your notes as you speak to your student. Please stop what you are doing, face them and make eye contact.

Use appropriate humour

Humour is a subjective emotional response, which has multi-dimensional value in preceptorship relationships, including bonding on a personal level, developing team cohesion, the release of dopamine that can promote positive thinking, creativity and reduce stress hormones increasing a person's ability to cope, enhance memory, increase self-esteem, optimism, and vigour. Humour can be a helpful coping strategy and help reframe and defuse a problem by putting it into perspective. However, humour is inappropriate in psychological crises and emergencies.

Appropriate humour can be a positive distraction, for example, when undertaking a clinical procedure such as a wound dressing or personal care, putting the student and the patient at ease.

Be aware of your nonverbal cues

Be careful that you do not send nonverbal cues that communicate exclusion.

Eye rolling, fidgeting, drumming your fingers, looking bored or away or allowing yourself to be distracted in the middle of a conversation.

Never compare your student to another student

When preceptors compare one student to other students, they typically compare what they lack to another student. This is not productive as it can be a biased comparison and will not help the current student achieve their goals.

“My last 4th-year student had no problem inserting an NG tube. Why is it that you cannot? I had expected you could complete this simple skill”.

Avoid exclusive patterns of social interaction (i.e., just with qualified nurses) as this will exclude students.

This creates invisible sociable barriers and a sense of exclusion. Be inclusive of the entire team.

Do you tend to interact with the same people outside what is required of your role? For example, do you always go to breakfast with the same nurses? Would you invite your student on the break with you? Avoiding this pattern of social exclusion leaves the invite open to all.